MEDICARE: NICHOLE HENRY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	169	TN

General Provider Information

NPI Number	:	1225259377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE HENRY BCBA

Provider Business Mailing Address
First Line	:	2347 ROSSVILLE BLVD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 FLYNN DR
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-2820
Country	:	US
Telephone Number	:	423-902-8137
Fax Number	:	888-817-2586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	12/03/2024

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